How do you apply hyperfractionated RT in the dose painting IMRT era in head and neck cancers?

Topics: Head and Neck Cancers • Radiation Oncology

Especially in patients who are not candidates for chemotherapy, what dose and fractionation should be applied given the fact that hyperfractionation was the long term "winner" in RTOG 9003?

Answer from: Radiation Oncologist at Academic Institution

I prefer to use the DAHANCA approach (Overgaard J et al, Lancet Oncol 2010) of providing 6 fractions weekly, 2 Gy per fraction, with a second fraction on a Fri (at 6 hours apart). This is an accelerated course delivering 72 Gy to the primary PTV over 6 weeks. Compared with other fractionated regime...

Comments

Radiation Oncologist at USC Keck School of Medicine
Thank you @Avraham Eisbruch, has the PTV1 for the ...

Radiation Oncologist at University of Michigan
I don’t think it was published but this is what ...

Answer from: Radiation Oncologist at Academic Institution

We have not adapted hyperfractionation (HFX) for non-chemotherapy patients with intermediate to advanced disease. I infer from the question that the concern with HFX is if treatment is in 68 fractions, what dose should be given to subclinical targets. I don't think anyone knows, and the simpler solu...

Answer from: Radiation Oncologist at Community Practice

At our facility, we also use @Avraham Eisbruch's approach of BID on Friday and target only the PTV1 in the afternoon. This strategy was learned from a pair of Danish H&N radiation oncologists I met at a conference in 2009. Not only did they take care of patients in Denmark, but they also practic...

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